Cervical spine tropism CII-CIII anomaly

Abstract

Study Design. 3 patients with CII-CIII tropism anomaly and unilateral subluxation were investigated and treated. Objectives. To demonstrate clinical and CT findings in children with the new anomaly in CII-CIII junction. Summary of Background data. A thorough in vivo research of CII-CIII junction became possible only after introduction of modern CT scanning technologies. We have not managed to find other clinical observations of this segment pathology in children in contemporary medical literature. Methods. We determined not typical cases of acute wryneck from the group of 262 children hospitalized in our clinic. X-ray and CT scans were used for evaluation of the problem. Results. From the group of patients with acute stiff-neck we selected three with the following symptoms: neck blocked and movement not possible; head advanced forward. On the lateral X-ray scans there were a cervical lordosis straightening and the pars interarticulares of the CII were overridden by the processus articularis superior of the CIII. The CT-scan of the cervical spine showed a unilateral subluxation of the CII segment in the forward direction. The articulation planes of the CII-CIII facets had different orientation on the left and right sides. Conclusion. We propose the hypothesis that non-symmetrical orientation of the articulation facet planes in the CII-CIII segment can cause a stiff-neck syndrome in children. In the described cases, the sole detected source of the pain syndrome and blocked neck was the tropism anomaly in the CII-CIII segment accompanied by a subluxation of the joint. Conclusions. Differential diagnosis is relevant both during the selection of surgical treatment tactics and in terms of patient’s legal status.